Q.W. Myers1,2, C. Chiapetta3, E. Hart-Rodriguez3, E. Nielsen3, R. Dicker4, R.N. Smith5, C.G. Velopulos1,2 1University Of Colorado Denver, Department Of Surgery, Aurora, CO, USA 2University Of Colorado Denver, Firearm Injury Prevention Initiative, Aurora, CO, USA 3University of Colorado Health, Aurora, CO, USA 4University Of California – San Francisco, Department Of Surgery, San Francisco, CA, USA 5Emory University School Of Medicine, Department Of Surgery, Atlanta, GA, USA
Introduction: In the Spring of 2023, we engaged Surgical Trauma Intensive Care Unit staff (STICU) at a level 1 Trauma Center to participate in the American College of Surgeons pilot implementation of a Trauma Informed Care (TIC) training. The training included a presentation, lived-experience expert, video-vignette reviews, and small group discussions on vicarious trauma. This study aims to explain the immediate outcomes of exposing STICU staff to a national TIC training.
Methods: In addition to mandatory national data collection, we conducted pre-, post-, and 3-month surveys with our participants using RedCap. We also collected over 40 hours of ethnographic observations in training sessions and 18 participant interviews. Interviews used a convenience sample of STICU staff during their shift while one author provided them a break. Interviews lasted on average 7 minutes. Quantitative data were analyzed with descriptive statistics and qualitative data was analyzed thematically.
Results: We trained 140 STICU staff from 16 disciplines. We collected 129 pre-surveys (92% response rate), 107 post-surveys (76%), and 58 3-month surveys (41%). 40.3% of respondents did not know what TIC was before the training dropping to 0% in the post- and 3-month surveys. After receiving the training respondents indicated that they found it easier to work with patients (68.9%), and that they believed their patients are now more appreciative of the care they receive (51.8%). Moreover, after the training participants also believed they had more control over their unit culture (35 to 52%) and strongly agreed that their work culture could change (10 to 26%). Interviews suggested a desire for training adapted to be more detailed on specific topics and to include more attending physicians. Participants further noted that they had not observed cultural change one month after the end of the training, but that many had changed their personal practices. Observations of the course demonstrated active participation with the material and small group discussions that allowed staff to commiserate over shared vicarious trauma.
Conclusion: TIC training has shown an important and effective understanding of the topic and changes in personal practices. Though the participants did not suggest culture change had happened quite yet, significant individual adaptations can eventually change culture. The increased belief in the ability for the unit culture to change also suggests hope on the part of those who are changing their practice to improve TIC. Moreover, participants suggested they felt they had more agency to change their culture after the training. The attrition of understanding is also indicative of the need for continued training including in-depth sessions on specific topics including vicarious trauma.